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Archive for the ‘psychiatry’ Category

evo-psychi.jpgThe last issue of the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry has a very interesting special issue on how evolutionary theory and psychology can be integrated into psychiatric theory about mental disease. It’s also called “evolutionary psychiatry“.

OK, you might ask; we can accept that evolutionary theory can explain why we behave as we do today, i.e. normal cognition and behaviour. But psyhiatric disease? Is this an attempt to explain the evolution of a disease? The straightforward answer is a resounding “no”. Evolutionary approaches to disease – including mental disease – is an attempt to describe and explain the design characteristics that make us susceptible to the disease (from Nesse & Williams, 1996). The evolutionary trajectories of humans is far from a travel towards perfection. We are full of errors and somatic and mental shortcomings – and the appendix, near-sightedness, and a bottleneck attentional system and the like are examples of this.

Another important issue is that the border between normal and abnormal psychology is becoming increasingly muddled. That may sound as a problem, but it’s actually caused by a change in our understanding of how our minds come to be, and especially how normal variation extends into pathological domains. In this sense, it’s hard to draw waterproof boundaries between normal and abnormal psychology. We work on a continuum, and the branch of modern evolutionary psychiatry makes a good case for such an approach.

Here is the introduction by Dan J. Stein:

Darwin wrote extensively on the implications of evolutionary theory for understanding human psychology, and made a special effort to gain access to observations on the insane. Pioneering ethologists, such as Tinbergen, emphasized the value of their work for understanding psychiatric disorders. Today, evolutionary psychology has become an accepted scientific field, and the area of evolutionary psychiatry has similarly shown increasing maturity. This special issue of “Progress in Neuropsychopharmacology and Biological Psychiatry” provides an opportunity to review some of these developments.

An introductory paper by Stein summarizes some of the history of evolutionary psychiatry in general, and considers its application to psychopharmacology in particular. Panksepp then outlines a number of conceptual issues at the heart of evolutionary psychiatry, arguing that there are flaws in much of the work that has been undertaken in evolutionary psychology and psychiatry, and proposing a novel way forwards. These introductory papers emphasize the possibility that the focus of evolutionary psychiatry on distal mechanisms can be usefully integrated with advances in our understanding of the proximal mechanisms that underpin psychopathology.

Several of the contributions in this issue go on to exemplify the application of the constructs of evolutionary psychiatry to particular mental disorders. Crow and Burns put forward different evolutionary approaches to schizophrenia, Allen and Badcock review evolutionary approaches to depression, Bracha focuses on the anxiety disorders, Feygin and colleagues on obsessive-compulsive disorder, and Baron–Cohen on autism. Although there are important challenges for evolutionary psychiatry going forwards, as the sophistication of its concepts and methods increases, so likely will its influence on the understanding of psychopathology.

A number of authors in the area of evolutionary psychiatry are also interested in more fundamental issues in evolution of brain and behavior. Thus, Crow is crucially concerned with the evolution of language, Burns emphasizes the evolution of social cognition, Baron–Cohen’s work touches on the importance of gender differences in systematizing and empathizing abilities, and Feygin and colleagues’ work addresses the evolutionary bases of religious ritual and loving attachment. Indeed, there is an argument that fundamental progress in evolutionary theory will be reliant on the resolution of key questions about mind and its illnesses.

-Thomas

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I have mentioned this as a headline at SCR. A new study demonstrates that Nalmefene, an experimental drug, has positive treatment effects on compulsive gambling. It works through making gambling become less thrilling and compelling. Maybe we can soon find a drug that makes statistics lectures more exciting, too?

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Multicenter investigation of the opioid antagonist nalmefene in the treatment of pathological gambling.

by Grant et al. in Am J Psychiatry. 2006 Feb ; 163(2): 303-12

OBJECTIVE: Pathological gambling is a disabling disorder experienced by approximately 1%-2% of adults and for which there are few empirically validated treatments. The authors examined the efficacy and tolerability of the opioid antagonist nalmefene in the treatment of adults with pathological gambling.

METHOD: A 16-week, randomized, dose-ranging, double-blind, placebo-controlled trial was conducted at 15 outpatient treatment centers across the United States between March 2002 and April 2003. Two hundred seven persons with DSM-IV pathological gambling were randomly assigned to receive nalmefene (25 mg/day, 50 mg/day, or 100 mg/day) or placebo. Scores on the primary outcome measure (Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling) were analyzed by using a linear mixed-effects model.

RESULTS: Estimated regression coefficients showed that the 25 mg/day and 50 mg/day nalmefene groups had significantly different scores on the Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling, compared to the placebo group. A total of 59.2% of the subjects who received 25 mg/day of nalmefene were rated as “much improved” or “very much improved” at the last evaluation, compared to 34.0% of those who received placebo. Adverse experiences included nausea, dizziness, and insomnia.

CONCLUSIONS: Subjects who received nalmefene had a statistically significant reduction in severity of pathological gambling. Low-dose nalmefene (25 mg/day) appeared efficacious and was associated with few adverse events. Higher doses (50 mg/day and 100 mg/day) resulted in intolerable side effects.

HubMed (cache)

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See also this story in The Nation

Drug Shows Promise in Curbing Compulsive Gambling, Study Says

By Robert Lee Hotz in The Nation

For the estimated 6 million compulsive gamblers in the U.S., the long odds are on a pill.

In the largest clinical study of its kind, researchers at the University of Minnesota found that daily doses of an experimental drug called nalmefene, often used to treat alcoholism, appeared to curb the craving to gamble.

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The research represents the latest effort to control the biology of misbehavior at a time when celebrity poker, online gambling, lotteries and sports betting have helped to make obsessive wagering a national psychiatric disorder.

“The study is part of emerging evidence that gambling, once thought to be a problem in moral integrity, is instead a problem in brain biology and can be successfully treated,” said Dr. Robert Freedman, editor of the American Journal of Psychiatry, which published the study today in its February issue.

(…)

The Nation

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